HomeMy WebLinkAbout613 S COLLEGE AVE - APPLICATIONS - 8/12/2011City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
,Fort Collins Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable/infor/m/ati n on the application.
Application # /3 �l 6 �—�" ��%
For office use only
Incomplete applications will not be accepted. .
Date �`s--/;7- //
Job Site Address (required) Value of Construction (labor, materials, profit)
Is this a residential or-ommerdal project? 'Residential Xcommerciai
If residential, is it: Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
X Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work /C
*If lawn Viinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I. have read this application and state that the above information is complete and correct I agree to
comply with all requirements contained herein and city. ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant:
PrintName: / nn �1j y. Si9 a - Date -/!